Summary: Physical Therapists use exercise progressions to teach patients and restore movement. Pilates equipment allows physical therapists to easily create exercise progressions to promote motor learning and progress a patient further along the rehab continuum.
As a Physical Therapist and Pilates/CoreAlign Master Instructor, I am continually impressed by the positive patient outcomes associated with Pilates as a treatment intervention. Proper application of Pilates in the clinical setting assists patients in establishing a solid foundation from which movement can occur successfully. To me, this happens in the form of progressions. Whether the patient is recovering from an acute injury, managing a disease process, or correcting a faulty movement pattern, progressions are important for neuromotor learning. Pilates equipment allows physical therapists (PTs) to easily create exercise progressions for skill acquisition in rehabilitation.
An effective progression to demonstrate this concept is the Pilates exercise of chest expansion.
Our posture is paying the price in our daily habits of working on a computer and looking at our smartphones. As a physical therapist, I use Pilates to activate the spine that is overstretched and underworked. This is called awakening the back body or posterior line.
(photo 1)
At first, the patient is introduced to the concept of maintaining an upright posture while managing a load while standing chest expansion at the Trapeze Table. Here she is able to feel and stabilize with grounding from the feet all the way to the upper body (photo 1).
Next, the exercise is taken to a kneeling position on the trap table. This is less stable as the patient no longer has the feedback from her feet and has to engage her core more to maintain a neutral pelvis and spine (photo 2).
(photo 2)
The next progression involves the challenge of a moving surface, i.e. the Reformer. The first step on the Reformer is seated on the box and is considered more supportive (photo 3).
(photo 3)
Once this stage is achieved, the exercise is progressed to the kneeling position (photo 4).
(photo 4)
The next step involves starting in a deep kneeling position on the carriage (photo 5).
As chest expansion is performed, the patient rises into tall kneeling (photo 6). This is a highly complex exercise in that the patient manages a moving surface, a rising/lowering body, and coordinates the timing of both phases. This requires mind-body control and proper application of all the previous steps.
(photo 5)
(photo 6)
The final progression depicted puts it all together in an upright position on the CoreAlign (photo 7).
The CoreAlign adds yet another layer of complexity that is necessary for further motor learning. For the patient to proficiently (and safely) perform the exercise and control both carts, she must apply all the concepts she learned during each of the previous progressions. This is neuromotor learning at its best. The patient now shows improved posture, coordination, mind-body connection, and balanced muscle development.
The above is just one of the thousands of possible exercise progressions. Pilates-based rehabilitation in the hands of a physical therapist is influential in creating change in the patient. Throughout this progressive process, not only is the patient building strength and freedom of movement, but she is also building mastery of skill and confidence. The progressions possible on the Pilates equipment spark creativity in the provider and are fun and rewarding for both the patient and PT.
